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La sepsi: facciamo il punto
No full textThe Sepsis Syndrome, as defined by the Consensus Conference, is a pathological condition with a high mortality and morbidity. In physiological condition an immunological cascade assures a prompt reaction to bacteria. A too much strong reaction can damage the host. The complexity of the immunological reaction makes difficult every specific therapy. Hypotension associated to septic shock is due to systemic vasodilation, myocardial depression and lead to multiorgan failure and death. Many sperimental and human studies indicate that this hypotension is due to the production of a large amount of nitric oxide (NO). The host reaction is so important as the site of the infection or the type of microorganism involved. Inflammation and coagulation are strictly linked. Many inflammatory mediators released during inflammation are also pro-coagulation and lead to sepsis. Moreover also the bacteria can cause an endothelial damage which a pro-coagulant action. During the last 15 years more then 20 multicenter trials have been performed to experiment new therapies. All these new therapies failed to reduce mortality. Only recently a new substance, C activated protein, with fibrinolitic, anti-inflammatory and anticoagulant properties, was able in PROWESS study to reduce significantly mortality of 6,1% with a reduction of the relative risk of 19,4%
The role of cardiac dysfunction in multiorgan dysfunction
No full textThe aim of this review was to examine the main determinants of cardiac dysfunction in critically ill patients, as well as how a reduction in cardiac performance influences other organ function
Correlation between hyperglycemia and mortality in a medical and surgical intensive care unit
No full textAbstract
AIM: The aim of this study was to assess the correlation between hyperglycemia and mortality in a group of patients admitted to a medical and surgical ICU and to evaluate if the association between hyperglycemia and reason of ICU admission significantly worsens patients' outcomes. METHODS: A retrospective clinical study was conducted in the ICU of a University Hospital. Four-hundred and twelve adult patients admitted to our ICU were enrolled. The blood glucose level was measured at the time of admission and daily at 2-4 h intervals. When the glucose level exceeded 180 mg/dL, an insulin bolus or a continuous infusion were performed to maintain the glucose level at or below 180-200 mg/dL. RESULTS: Analysing the mean blood glucose levels of patients with the receiver operating characteristic (ROC) curve, it resulted that the blood glucose level of 141.7 mg/dL had higher sensitivity (76%) and specificity (56.5%) to discriminate the probability of death. In other words, in pati..
Desflurane Versus Sevoflurane to Reduce Blood Loss in Maxillofacial Surgery
No full textAbstract: Purpose: In our study, desflurane was hypothesized to reduce blood loss more than sevoflurane, both used with targeted mild controlled hypotension.
Patients and Methods: A total of 20 American Society of Anesthesiologists Class I patients undergoing maxillofacial elective surgery for maxillary and mandibular osteotomies were randomized to a desflurane group or a sevoflurane group. Anesthesia was performed with an end tidal value of the inhaled agent to obtain a bispectral index valu
Behavior of B-type natriuretic peptide during mechanical ventilation and spontaneous breathing after extubation
No full textAbstract: Background. The behavior of B-type natriuretic peptide (BNP) is assessed during mechanical ventilation (MV) and spontaneous breathing after extubation in critical patients.
Methods. Thirty patients admitted in the Intensive Care Unit (ICU) were enrolled. BNP, fluid balance (1713), airway pressure (AP) and dobutamine infusion needing (DP) were registered in three stages: TO, admission to ICU; T1, before extubation; T2, 24 h after extubation.
Results. Patients with congestive heart failure (CHF) had BNP values higher than other patients. The value of BNP during MV was greater than normal in all patients. The cut-off to discriminate patients with heart failure during MV was 286 pg.mL(-1) (sensitivity: 86%; specificity: 90%). The increase of BNP during MV directly correlated with FB and inversely correlated with A-P and DP. The plasmatic level of BNP remained higher than normal values 24 h after extubation.
Conclusion. The underlying disease of all ICU patient seems t..
Prolonged prone positioning in ARDS: No mortality benefit, no increased risk-But what about the reduced ICU staff workload?
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